Objective To explore the application value of three mainstream large language models in the diagnosis, differential diagnosis, and treatment decision support of the primary diseases related to pediatric liver transplantation. Methods Seventy-nine cases of pediatric liver transplantation-related diseases diagnosed through pathological or clinical follow-up data were collected from Renji Hospital, Shanghai Jiao Tong University School of Medicine or published high-quality case reports. These cases covered 25 types of primary diseases such as cholestatic liver disease, metabolic diseases, and tumors. Standardized prompts were used to input the case information into the DeepSeek-R1, ChatGPT-4o and Grok-3 models, and the accuracy of their preliminary diagnosis and differential diagnosis based on basic clinical data was evaluated. The final diagnosis accuracy and the response time after supplementary examination were also assessed, as well as the completeness and rationality of their analysis of disease treatment principles. Results In the initial diagnosis and differential diagnosis stage, the comprehensive accuracy of DeepSeek-R1 was the highest [72.1%, 95% confidence interval (CI) 61.4% - 80.8%], and there was a statistically significant difference in the comprehensive accuracy of the three models for initial diagnosis (P = 0.008). After adding further examination information, the final diagnosis accuracy of the three models increased, with DeepSeek-R1 at 88.6% (95% CI 79.7% - 93.9%), ChatGPT-4o at 87.3% (95% CI 78.2% - 93.0%), and Grok-3 at 78.5% (95% CI 68.2% - 86.1%). There was no statistically significant difference among the three models (P = 0.05). The scores given by experts for the treatment principles showed good consistency (Kappa = 0.769). In addition, the response time of ChatGPT-4o is shorter than that of the other two models [(24 ± 7) s]. Conclusions Large language models demonstrate good efficacy in the diagnosis and treatment decision-making process of various pediatric liver diseases, have a good application prospect for auxiliary diagnosis and decision support, and are expected to help improve the accuracy and efficiency of clinical diagnosis and treatment of pediatric liver transplantation-related primary diseases.

In recent years， repetitive transcranial magnetic stimulation （rTMS） has garnered significant attention as a therapeutic approach for sleep disorders in the elderly. However， the prevailing rTMS protocols are predominantly developed based on normative neurophysiological data derived from young adults and fail to incorporate individualized parameters tailored to the brain characteristics of the elderly. To address this gap， the consensus development group synthesized the latest evidence from 2010 to 2025 and established a standardized rTMS protocol specifically for elderly patients with sleep disorders. Adhering to the Appraisal of Guidelines for Research and Evaluation II （AGREE II） framework， systematically screened randomized controlled trials （RCTs） and systematic reviews regarding rTMS in the treatment of sleep disorders across various conditions. Meanwhile， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system was employed to rigorously grade the quality of evidence and the strength of recommendations. This consensus guideline delineates precise rTMS protocols for the management of sleep disorders in the elderly， highlights the adjustment of stimulation intensity according to scalp-cortex distance recommends either MRI‑guided neuronavigation or the Beam F3/F4 heuristic approach for accurate target localization， thereby providing precise rTMS intervention protocol for sleep disorders in the elderly， aiming to enhance clinical efficacy while ensuring treatment safety. ［Funded by National Key Research and Development Program （number， 2023YFC3603200）； General Program of Shenzhen Science and Technology Innovation Commission （number， JCYJ20240813112859008， JCYJ20240813112900002）； Youth Program of Shenzhen Kangning Hospital （number， KN2023A004）； www.guidelines-registry.cn number， PREPARE-2026CN530］

Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated death globally. Liver transplantation (LT) has emerged as a key treatment for patients with HCC, and the Milan criteria have been adopted as the cornerstone of the selection policy. To allow more patients to benefit from LT, a number of expanded criteria have been proposed, many of which use radiologic morphological characteristics with larger and more tumors as surrogates to predict outcomes. Other groups developed indices incorporating biological variables and dynamic markers of response to locoregional treatment. These expanded selection criteria achieved satisfactory results with limited liver supplies. In addition, a number of prognostic models have been developed using clinicopathological characteristics, imaging radiomics features, genetic data, and advanced techniques such as artificial intelligence. These models could improve prognostic estimation, establish surveillance strategies, and bolster long-term outcomes in patients with HCC. In this study, we reviewed the latest findings and achievements regarding the selection criteria and post-transplant prognostic models for LT in patients with HCC.

Aim To investigate the effect of p-AMPK activity on autophagy in different subtypes of MDA-MB-231(triple-negative breast cancer cells)and MCF-7(estrogen receptor-positive cells)and its regulatory mechanism.Methods MDA-MB-231 cells were trea-ted with EBSS,Baf-A1,and EBSS+Baf-A1 for four hours,and MCF-7 cells for eight hours.The effects of autophagy on cell proliferation and apoptosis were ob-served,mitochondrial morphology was examined,and the expression of autophagy markers LC3B,P62,LAMP1,TOM20,AMPK,p-AMPK,ULK1,and Bec-lin1/VPS34 proteins was detected.The autophagy pathway was validated by inhibiting AMPK activity.Results Breast cancer cells underwent autophagy af-ter starvation induction(EBSS),with inconsistent au-tophagy processes observed in different subtypes of breast cancer cells.Autophagy inhibited cell prolifera-tion.In MDA-MB-231 cells,autophagy led to an in-crease in p-AMPK levels and a decrease in ULK1 lev-els,initiating autophagy through p-AMPK activation of ULK1.In MCF-7 cells,both p-AMPK and ULK1 levels decreased after autophagy,suggesting that autophagy might not be mediated by p-AMPK activation.Conclu-sions MDA-MB-231 cells primarily initiate autophagy by directly activating ULK1 by p-AMPK,independent of the MTOR pathway.In MCF-7 cells autophagy might be triggered by inhibiting MTOR through AMPK activity or directly activating MTOR through other up-stream factors.Regulating p-AMPK activity based on the autophagy pathways in different cell subtypes could enable more precise targeting and treatment of different types of breast cancer.

Objective To analyze the direct economic burden caused by surgical site infection(SSI)in orthopedics and joint surgery,and provide evidence-based support for intervention measures.Methods 3 348 hospitalized pa-tients in the department of orthopedics and joint surgery of a hospital from July 2021 to July 2023 were selected.They were divided into an infection group and a control group based on whether they had SSI.The propensity score matching(PSM)method was adopted to match the two groups of patients in a 1∶1 ratio.The length of hospital stay and various hospitalization expenses between patients with different types of SSI and control group were compared.Results Among 3 348 hospitalized patients,259 had SSI,with an incidence of 7.74％.Superficial incisional wound infection had the highest number of patients(n=177,68.34％),followed by deep incisional wound infection(n=65,25.10％),organ/space infection had the lowest number of patients(n=17,6.56％).After PSM matching,257 pairs were successfully matched,with a matching rate of 99.23％.Infection group extended length of hospital stay by 18 days compared with the control group(P＜0.001).The total hospitalization expenses and individual hos-pitalization expenses of infection group were all higher than those of the control group(all P＜0.001).Among the various expenses,difference in drug expense was the largest,with an increase of 5 067.83 Yuan in Western medi-cine(P＜0.001)and 957.30 Yuan in antimicrobial agents(P＜0.001).Patients with different types of SSI all had longer hospital stay compared with the control group.Patients with deep incisional wound infection,superficial inci-sional wound infection,and organ/space infection had an extended hospital stay of 26,18,and 13 days,respectively(all P＜0.05).The total hospitalization expenses,Western medicine expenses,and antimicrobial agent expenses of patients with different types of SSI were all higher than those of the control group(all P＜0.05).Conclusion The occurrence of postoperative SSI in patients in the department of orthopedics and joint surgery can prolong the length of hospital stay,resulting in huge economic losses for the patient and the hospital.Effective control of healthcare-associated infection is of great significance for optimizing medical resources,improving medical quality,and ensuring patient safety.

AIM To compare total sugar,total protein,total phenol,total flavonoid,calycosin-7-O-β-D-glucoside,liquiritin,lobetyolin,quercetin,isoferulic acid,hesperidin,glycyrrhizic acid contents and their antioxidant activities,hypoglycemic activities of big honey pill,small honey pill,water pill,concentrated pill,granule,mixture and decoction of Buzhong Yiqi Recipe.METHODS Anthraquinone-sulfuric acid method,Coomassie brilliant blue method,Folin-phenol colorimetry method,sodium nitrite-aluminum nitrate method and HPLC were adopted in the content determination of total sugar,total protein,total phenol,total flavonoid and seven constituents,respectively,after which the scavenging capacities,reducing powers on DPPH·free radical,ABTS+free radical,hydroxyl free radical,and inhibition capacity on α-glucosidase activity were detected.Subsequently,correlation analysis was performed.RESULTS Total sugar,total protein,total phenol and total flavonoid contents demonstrated significant differences among different dosage forms(P＜0.05,P＜0.01).Calycosin-7-O-β-D-glucoside,glycyrrhizin,codonoside and quercetin displayed the highest contents in the decoction,while those of isoferulic acid,hesperidin and glycyrrhizin were observable in the mixture.The water pill exhibited the strongest antioxidant activity,while those of the concentrated pill and mixture were weak;the big honey pill exhibited the strongest hypoglycemic activity,while that of the decoction was the weakest.Total protein,total phenol,total flavonoid and liquiritin contents displayed significant positive correlations between antioxidant activity(P＜0.05,P＜0.01),while hesperidin content displayed significant negative correlation between the latter(P＜0.05);total protein,calycosin-7-O-β-D-glucoside,codonoside and quercetin contents displayed significant negative correlations between hypoglycemic activity(P＜0.05,P＜0.01).CONCLUSION Active constituent contents and their biological activities of Buzhong Yiqi Recipe with different dosage forms exist differences,total sugar,total protein,total flavonoids,calycosin-7-O-β-D-glucoside,licorice glycoside,hesperidin,codonoside and quercetin can be taken as quality control indices for this prescription.

Non-small cell lung cancer(NSCLC)is one of the most common and deadly malignant tumors worldwide,with surgical resection being the primary treatment for early-stage NSCLC.Tumor spread through air spaces(STAS)is a novel pattern of tumor dissemination into the air spaces in the lung.Its occurrence after sublobar resection is closely associated with recurrence and distant metastasis,making its con-sideration a vital factor in surgical strategy selection and prognostic evaluation.Patients with STAS-positive status exhibit significantly higher postoperative recurrence rates than do STAS-negative patients,with molecular mechanisms involving tumor microenvironment remodeling,specific genetic mutations,and epithelial-mesenchymal transition(EMT).Imaging techniques including computed tomography(CT)and positron emission tomography/CT have shown potential for preoperative STAS prediction,although their accuracy and practicality require improvement.This paper reviews the definition,pathological characteristics,and related mechanisms of STAS,with a focus on surgical ap-proach selection for STAS-positive patients and its role in cancer recurrence after sublobar resection of early-stage NSCLC.Future research directions include optimization of preoperative diagnostic methods for STAS,exploration of molecular targeted therapies,and development of imaging-based precision prediction models.

Objective:To explore the correlations between the monocytes/high-density lipoprotein ratio (MHR), alkaline phosphatase (ALP), and all-cause mortality in patients undergoing maintenance peritoneal dialysis (PD), and to provide references for clinical prevention and treatment strategies.Methods:A retrospective analysis was conducted on the clinical data of 336 PD patients who were treated in the Affiliated Hospital of Jining Medical University from June 2014 to August 2023. According to the survival status of the patients during the follow-up period, they were divided into the death group ( n=55) and the survival group ( n=281). The differences in clinical data, blood routine, laboratory biochemical indicators, monocyte count, high-density lipoprotein cholesterol, and ALP indicators between the two groups were collected and compared. Multivariate Cox regression analysis was used to screen the risk factors for all-cause mortality in PD patients, and Pearson correlation analysis was used to evaluate the correlation between the survival time of patients and related indicators. Results:In this study, there were 55 patients who died of all causes. The causes of death were cardiovascular events in 26 cases (47.27%), gastrointestinal bleeding in 3 cases (5.45%), infection in 7 cases (12.73%), multiple organ failure in 8 cases (14.55%), and unexplained death in 11 cases (20.00%). There was no statistically significant difference in gender, age, weight, serum parathyroid hormone (PTH), and total cholesterol (TC) between the death group and the survival group (all P>0.05). The treatment time, neutrophil count, red blood cell volume distribution width (RDW), ALP, blood uric acid (UA), blood calcium, MHR and creatinine in the death group were all higher than those in the survival group (all P<0.05), while the lymphocyte count was lower than that in the survival group ( P<0.05). The Cox risk model showed that MHR, ALP, treatment duration, neutrophil count, lymphocyte count, RDW, UA, and creatinine were independent risk factors for all-cause mortality in PD patients ( OR=1.578, 2.881, 1.021, 1.122, 1.476, 2.231, 1.018, 1.008, all P<0.05); Pearson correlation analysis revealed that the survival time of PD patients was negatively correlated with MHR and ALP ( r=-0.305, -0.246, all P<0.05). Conclusions:The levels of MHR and ALP are closely related to the risk of all-cause mortality in PD patients and are independent risk factors for all-cause mortality in patients.

Aim To investigate the role of triggering receptor expressed on myeloidcells 2(TREM2)in syn-aptic plasticity induced by cocaine addiction.Methods C57BL/6J mice and Trem2 knockout mice were uti-lized in this study to evaluate the alterations in postsyn-aptic density protein 95(PSD-95)and synapsin 1(SYN1)within the cortex and hippocampus of co-caine-addicted mice by using immunological tech-niques.Results HE staining and Nissl staining showed increased neuronal damage in the hippocampus and cortex of mice after cocaine addiction.The results of immunohistochemistry and fluorescence of PSD-95 and SYN1 were consistent with the expression trend of Western blot.In the wild type mouse model,the ex-pression level of PSD-95 in the hippocampus and cortex was lower than that in the saline group,and the ex-pression of SYN1 was higher than that in the saline group.In the knockout mouse model,the expression levels of PSD-95 and SYN1 in the hippocampus and cortex were significantly higher than those in the saline group after cocaine addiction.The expression levels of PSD-95 and SYN1 in the hippocampus and cortex of cocaine knockout mice were higher than those of co-caine wild type mice.Conclusion Cocaine addiction can change the synaptic plasticity,and TREM2 plays a regulatory role in the synaptic plasticity of hippocampus and cortex in mice with cocaine injury.TREM2 is ex-pected to be a new target for studying the mechanism of cocaine addiction.

Objective:To explore the specific mechanism of Baijiesan on microangiogenesis of wound after perianal abscess in rats by regulating RAS signal pathway.Methods:A total of 72 SD rats were divided into control group,model group,Baijiesan group and Baijiesan+farnesylthiosalicylic acid(FTS)group,with 18 rats in each group.Cut off the whole layer of skin on the back of rats.The model group,Baijiesan group and Baijiesan+FTS group were treated with fecal supernatant,while the control group was treated with normal saline.After the successful establishment of the model,Baijiesan+FTS group were treated with Baijiesan and received in-traperitoneal injection of FTS,while Baijiesan group were treated with Baijiesan only.The back wound images of rats were taken after successful modeling(day 0),4 days,8 days and 12 days after treatment,and the wound healing rate was calculated.After 4 days,8 days and 12 days of treatment,6 rats in each group were randomly selected and killed,the new wound healing tissue was removed,and the blood of abdominal aorta of rats after treatment for 12 days was collected.Histopathological morphology of wound tissue was observed by HE and Masson staining.Immunohistochemistry was used to detect the number of microvessels.ELISA was used to detect serum inflammatory markers.RAS signal pathway and angiogenesis-related molecules were detected by qRT-PCR and Western blot.Results:Compared with control group,the wound healing rate of model group,Baijiesan group and Baijiesan+FTS group decreased at each time point(P<0.05),while the number of microvessels,the levels of TNF-α,IL-1β,IL-6,RAS and Raf-1,VEGF,VEGFR2 mRNA and protein,ERK1,ERK2 mRNA,p-MEK1/2,p-ERK1/2 protein expressions were increased(P<0.05).Compared with model group and Baijiesan+FTS group,the wound healing rate,the number of microvessels,RAS,Raf-1,VEGF,VEGFR2 mRNA and protein,ERK1,ERK2 mRNA,p-MEK1/2,p-ERK1/2 protein expressions were further increased in Baijiesan group(P<0.05),while the levels of TNF-α,IL-1β and IL-6 were decreased(P<0.05).Conclusion:Baijiesan can reduce the level of wound inflamma-tion after operation of perianal abscess,and may enhance the ability of wound angiogenesis and wound healing by promoting RAS signal pathway.